Revision Knee Replacement in Birmingham
Specialist revision of failed knee replacements for loosening, infection, instability, stiffness and periprosthetic fracture. Mr Hussain trained at ENDO-Klinik Hamburg in complex revision arthroplasty and performs knee revision surgery at all three Birmingham private hospitals.
Total procedures
498 verified reviews
ENDO-Klinik Hamburg
Medically reviewed by Mr Shakir Hussain, MBBS MRCS FRCSEd (Tr & Orth), Consultant Orthopaedic Surgeon · Last reviewed: June 2026 · Next review due: June 2029
In Short
Knee revision surgery replaces one or more components of a knee replacement that has failed because of loosening, infection, instability, stiffness, wear, or fracture. It is significantly more complex than primary knee replacement and relies on CT-based pre-operative planning, the right level of implant constraint, and often stems and augments to rebuild a stable, pain-free knee. The operation typically takes 2 to 4 hours, most patients stay 3 to 5 nights, and full recovery usually takes 3 to 6 months. Mr Shakir Hussain performs revision knee replacement privately in Birmingham, with every package individually quoted after consultation and imaging review.
Also known as: revision knee arthroplasty, revision total knee replacement (revision TKA), redo knee replacement. This page covers revision of a failed knee replacement; if you are considering a first-time replacement, see the knee replacement page.
On This Page
Overview
What Is Knee Revision Surgery?
Knee revision surgery replaces failed or failing components of a primary knee replacement. It is a significantly more demanding operation than a first-time knee replacement, requiring careful pre-operative assessment and planning, specialised implants, and a surgeon experienced in managing the unique challenges of redo knee surgery. A difficult first-time knee that has never been replaced is a different problem, covered in the guide to complex knee replacement in Birmingham.
The complexity of knee revision arises from multiple factors: scar tissue from the previous surgery restricts surgical access; bone loss on the femoral or tibial side may require augmented implants, stems, and bone grafting; and the degree of ligamentous instability determines the level of implant constraint required, from a simple tibial insert exchange through to a fully rotating hinge prosthesis.
Pre-operative workup is thorough and typically includes CT scanning for 3D bone stock assessment and implant templating, blood tests (CRP, ESR, white cell count), and knee aspiration if infection is clinically suspected. Accurate diagnosis of the failure mode drives the surgical plan.
Mr Hussain trained at ENDO-Klinik Hamburg under Professor Thorsten Gehrke and Professor Mustafa Citak, gaining subspecialty experience in complex revision arthroplasty. He performs knee revision surgery at the Royal Orthopaedic Hospital Birmingham, Priory Hospital Edgbaston, and Harborne Hospital.
- Full pre-operative workup including CT templating for all complex cases
- Intraoperative access to primary-style through to fully constrained hinge implants
- Bone defect management with stems, augments, wedges, and bone grafting
- Collaboration with specialist infection and microbiology teams
- All three Birmingham private hospitals for patient convenience
Causes of Failure
Why Do Knee Replacements Fail?
Identifying the precise cause of knee replacement failure is the most important step before planning revision surgery. Different failure modes demand entirely different surgical solutions.
Aseptic Loosening
The bond between the tibial or femoral component and the underlying bone breaks down without infection. This may result from inadequate initial fixation, stress shielding, or osteolysis caused by wear debris. Patients notice progressive pain, particularly on weight-bearing, confirmed by component migration or radiolucency on X-ray or CT; our knee implant loosening page covers the symptoms and diagnosis in detail. Revision requires removal of the loose component, bone preparation, and re-implantation with a more stable fixation strategy.
Periprosthetic Joint Infection
Infection around the knee replacement is a serious complication that may present early after primary surgery or late, sometimes from a distant source such as a urinary tract infection or dental procedure. It causes persistent pain, swelling, warmth, and occasionally wound discharge or fever, though indolent infections may have more subtle signs. Surgical management depends on the timing and nature of infection: DAIR surgery for early acute cases, or two-stage revision for established infection.
Instability
Knee replacement instability results from ligament imbalance, collateral or posterior cruciate ligament deficiency, or component malposition creating asymmetric laxity. Patients experience a feeling of the knee giving way, difficulty on stairs, and pain with activity. Treatment depends on severity: a thicker polyethylene insert may correct mild flexion instability, while significant multi-directional instability requires revision with a higher-constraint implant, such as a constrained condylar or rotating hinge prosthesis.
Stiffness and Arthrofibrosis
Severe stiffness after knee replacement is distressing and functionally limiting. It may result from inadequate post-operative physiotherapy, a component sizing or positioning issue, or excessive scar formation (arthrofibrosis). Manipulation under anaesthesia is appropriate for early stiffness. Established arthrofibrosis with a structural cause (such as component overhang or an oversized femoral component) may require revision surgery to correct the underlying problem alongside arthroscopic or open scar release.
Implant Wear
Polyethylene bearing surface wear over time generates debris particles that trigger an osteolytic reaction in the surrounding bone. Modern highly cross-linked polyethylene bearings have greatly reduced wear rates, but older implants remain susceptible. Isolated polyethylene liner exchange may be appropriate if the tibial tray and femoral component are well fixed and undamaged; bone loss from osteolysis typically requires more comprehensive revision with augmented implants.
Periprosthetic Fracture
Fracture around a knee replacement, most commonly in the distal femur or proximal tibia, typically follows a fall in an older patient. Management depends on fracture pattern, bone quality, and implant stability. A well-fixed implant with an appropriate fracture pattern may be treated with internal fixation. Loose implants, comminuted fractures involving the joint surface, or poor bone stock favour revision surgery with a distal femoral replacement or a stemmed revision implant bypassing the fracture.
Case example: failed partial knee replacement revised to a robotic-assisted total knee replacement
A patient whose partial (unicompartmental) knee replacement had become increasingly painful and stiff, with arthritis progressing across the rest of the joint and movement severely limited despite repeated manipulations and extensive physiotherapy (left). After multidisciplinary review, Mr Hussain revised it to a total knee replacement using CORI robotic assistance, removing the implants with minimal bone loss and correcting the deformity, with a stemmed tibial component for secure fixation and patella resurfacing (right). By the end of the operation the knee moved freely from 0 to 140 degrees.
Surgical Planning
Implant Options in Knee Revision
One of the most critical decisions in knee revision surgery is the level of implant constraint required. This is determined by the integrity of the collateral and posterior cruciate ligaments, the degree of bone loss, and the specific failure mode being addressed. Mr Hussain plans each case individually using CT-based templating, with intraoperative flexibility to adjust the plan based on what is found at surgery.
Primary-Style Revision Components
In cases where bone loss is minimal, ligaments are intact, and the reason for revision is isolated liner wear or a single loose component, a primary-style revision using a standard tibial tray or femoral component with a thicker insert may be sufficient. This preserves the most bone and offers the lowest-constraint option.
Constrained Condylar Knee (CCK)
The CCK implant provides greater inherent stability than a standard primary implant through a deeper post-and-cam mechanism that controls varus-valgus and rotational forces. It is appropriate when the collateral ligaments are incompetent or a gap imbalance cannot be corrected with soft tissue adjustment alone. Stems are typically added on the femoral and tibial sides to distribute load into the diaphysis and protect the bone-implant interface.
Rotating Hinge Implant
When collateral ligament function is absent or irreparable, a rotating hinge prosthesis provides full coronal and sagittal stability while allowing physiological axial rotation. This implant is also used for severe bone loss, distal femoral replacement scenarios, and complex fractures. Long intramedullary stems on both sides are required. While functional outcomes are good in appropriately selected patients, the rotating hinge is a last-resort option due to its fixed-implant characteristics and higher mechanical demands on the bone-cement or bone-implant interface.
Stems, Augments and Wedges
Bone defects on the tibial or femoral side are classified using the Anderson Orthopaedic Research Institute (AORI) system to guide reconstruction. Contained cavitary defects can be filled with morselised bone graft or metaphyseal cones. Uncontained defects require metal augments or wedges to restore the joint line and provide a stable platform for the implant. Intramedullary stems are almost always used in revision surgery to distribute load beyond the reconstructed metaphysis into healthy diaphyseal bone.
The Operation
How Is Knee Revision Surgery Performed?
Every knee revision is planned individually. The operation is usually performed under spinal or general anaesthetic, chosen with a specialist anaesthetist; our guide to spinal versus general anaesthetic explains the options. Surgery follows two broad stages: removing the failed components while preserving as much healthy bone as possible, then reconstructing the knee with implants matched to the bone loss and ligament function found at surgery.
Implant Removal and Bone Preparation
The previous incision is used wherever possible, and scar tissue is carefully released to restore surgical access and movement. Failed components are removed with fine saws and osteotomes at the implant-cement or implant-bone interface, protecting the bone beneath; the extensor mechanism (kneecap tendon complex) is guarded throughout, as injury to it seriously compromises the result.
All cement and inflammatory membrane are cleared, and bone defects on the femoral and tibial sides are assessed against the pre-operative CT plan using the AORI classification. In infected cases, all foreign material and involved tissue are excised and the joint is thoroughly lavaged before any reconstruction or antibiotic spacer is placed.
Reconstruction and Balancing
The joint line is rebuilt first: contained defects are filled with bone graft or metaphyseal cones, and uncontained defects with metal augments or wedges. Intramedullary stems on the femoral and tibial sides carry load past the reconstructed area into healthy bone.
Trial components are then used to balance the knee through its full range, and the definitive level of constraint is confirmed: a primary-style insert where ligaments are sound, a constrained condylar implant for collateral deficiency, or a rotating hinge where ligament function is absent. The patella is assessed and resurfaced or revised where needed, and stability, tracking, and leg alignment are checked before the final components are fixed.
Getting Back On Your Feet
Recovery After Knee Revision Surgery
Recovery takes longer than after a primary knee replacement, and regaining range of movement and quadriceps strength is the central focus from day one. Most patients follow a path like this:
- Day of surgery to day 1: standing and walking with physiotherapy support, and early knee bending exercises begin.
- Days 3 to 5: discharge home once pain is controlled, the wound is settled, and you are safe with walking aids.
- Weeks 1 to 6: progressive physiotherapy for range of movement and quadriceps strength; weight-bearing is protected where the reconstruction requires it.
- Months 3 to 6: meaningful improvement in pain and day-to-day function for most patients.
- Months 12 to 18: maximum function is reached.
Because these are demanding reconstructions, follow-up is closer than after primary surgery, with reviews at 6 weeks, 3 months, 6 months, and 12 months, and physiotherapy support throughout.
Fees & Funding
Knee Revision Surgery Cost in Birmingham
Mr Hussain's knee revision packages at the Royal Orthopaedic Hospital cover the surgeon's fee, the anaesthetist, the revision implant system, and your hospital stay. Because no two revisions are alike, from a partial-to-total conversion to a full single-stage revision, every package is quoted individually after your imaging has been reviewed, so you receive a fixed, written, all-inclusive quotation before deciding to proceed. As the private care arm of a dedicated NHS orthopaedic hospital, ROH Private Care offers some of the most competitive knee revision prices in the UK.
Treatment is covered by all major private medical insurers: Bupa, AXA, Vitality, WPA, and Aviva. Mr Hussain is fee-assured with the major insurers, and Wendy, his secretary, can guide you through authorisation; our insurance pre-authorisation guide explains the process step by step. Full details, including what each package covers, are on the fees and pricing page.
Revision Surgery in Birmingham
Why Choose Mr Hussain for Revision Surgery?
Mr Hussain holds a subspecialty fellowship from ENDO-Klinik Hamburg, one of the world's leading centres for revision arthroplasty, and has contributed 33 peer-reviewed publications to the orthopaedic literature. His practice at the Royal Orthopaedic Hospital, Priory Hospital Edgbaston, and Harborne Hospital is built on a foundation of 5,000+ procedures and a Doctify rating of 4.98 from 498 verified reviews.
Explore his revision hip and knee outcomes and learn how to read your surgeon's NJR results.
Key Takeaways
Knee Revision Surgery at a Glance
- Knee revision replaces one or more components of a failed knee replacement; the most common causes are aseptic loosening, infection, instability, stiffness, wear, and periprosthetic fracture.
- Establishing why the knee failed comes first: blood tests, knee aspiration where infection is suspected, and CT-based templating shape the surgical plan.
- The level of implant constraint is matched to ligament function, from a simple insert exchange through constrained condylar implants to a rotating hinge, with stems, augments, and cones addressing bone loss.
- Recovery is slower than after primary knee replacement: meaningful improvement by 3 to 6 months, with range of movement and quadriceps strength the central focus of physiotherapy.
- Mr Hussain's revision training comes from ENDO-Klinik Hamburg, one of the world's highest-volume centres for revision arthroplasty.
- Competitively priced self-pay packages, individually quoted after consultation and imaging review; all major private medical insurers are accepted.
Patient Questions
Frequently Asked Questions
References and further reading
- NHS. Knee replacement. nhs.uk/conditions/knee-replacement
- National Joint Registry (NJR). Annual reports and implant performance data. njrcentre.org.uk
- National Institute for Health and Care Excellence (NICE). Joint replacement (primary): hip, knee and shoulder, NG157. nice.org.uk/guidance/ng157
- Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR. How long does a knee replacement last? The Lancet, 2019. thelancet.com
Medically reviewed by Mr Shakir Hussain, Consultant Orthopaedic Surgeon. Last reviewed: June 2026. Next review due: June 2029.
Ready to Discuss Your Revision Surgery?
Book a private consultation with Mr Hussain at the Royal Orthopaedic Hospital, Priory Hospital Edgbaston, or Harborne Hospital.